The following is a review of some of the work we have done since 2004 regarding the importance of molds and their mycotoxins in the phenomenon of sick building syndrome (SBS). In these studies we showed that the macrocyclic trichothecene mycotoxins (MTM) of Stachybotrys chartarum (SC) are easily dissociated from the surface of the organism as it grows and could therefore be consequently spread in buildings as the fungus experiences additional water events. We then showed that SC and Penicillium chrysogenum (PC) colonies remain viable long after a water source has been removed, and the MTM produced by SC remain toxic over extended periods of time. We next showed that PC when inhaled, can release in vivo, a protease allergen that can cause a significant allergic inflammatory reaction in the lungs of mice. We then showed, in a laboratory study, that the MTM of SC can become airborne attached to spores or SC particulates smaller than spores. Following that study, we next showed that the same phenomenon actually occurred in SC infested buildings where people were complaining of health problems potentially associated with SBS. Finally, we were able to demonstrate the presence of MTM in the sera of individuals who had been exposed to SC in indoor environments.

Dampbuilding-related illnesses (DBRI) include a myriad of respiratory, immunologic, and neurologic symptoms that are sometimes etiologically linked to aberrant indoor growth of the toxic black mold, Stachybotryschartarum. Macrocyclic trichothecenemycotoxins, produced by one chemotype of this fungus, are potent translational inhibitors and stress kinase activators that appear to be a critical underlying cause for a number of adverse effects. Notably, these toxins form covalent protein adducts in vitro and in vivo and, furthermore, cause neurotoxicity and inflammation in the nose and brain of the mouse. A second S. chartarum chemotype has recently been shown to produce atranones-mycotoxins that can induce pulmonary inflammation. Other biologically active products of this fungus that might contribute to pathophysiologic effects include proteinases, hemolysins, beta-glucan, and spirocyclic drimanes.

An extensive growth of Stachybotrys in water-damaged buildings is of great public health concern. It is inconclusive whether Stachybotrys is responsible for the reported health effects on the occupants in these contaminated environments. However, based on the veterinary, occupational and laboratory toxicity studies, it is reasonable to project that Stachybotrys can cause adverse health responses once the toxic level of the corresponding agents reached the target systems.

Stachybotryschartarum, a fungus found in damp buildings and sometimes ascribed a role in building-related illnesses, produces a variety of secondary metabolites including trichothecenes, triprenylated phenolics, and a new class of diterpenoids called atranones. A related fungus, Memnoniella echinata also produces trichothecenes and the triprenylated phenolics.

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Revankar Sanjay G.. Clinical implications of mycotoxins and Stachybotrys. The American journal of the medical sciences. 2003;325:262–274. PMID: 12792245

This review summarizes what is known regarding health effects of mycotoxins in general and specifically examines the evidence for the role of indoor exposure to the fungi of the genus Stachybotrys as a cause of disease in humans. The risk of health effects from ingestion seems much more widespread than from indoor airborne exposure, although the latter has received considerably more media attention.

It is generally accepted that living or working in mouldy environments is associated with building related asthma, exacerbating asthma in mould-sensitive asthmatics and increased rates of upper respiratory disease. There is limited evidence that severe lung damage can occur from building exposure to S. chartarum but possibly only under conditions of exposure that approach those associated with handling contaminated straw. There is no positive evidence in the literature to account for putative neurological damage resulting from exposure to this mould.

Epidemiologic evidence has demonstrated an association between acute pulmonary hemorrhage in infants and exposure to Stachybotrys and other fungi in water-damaged home environments. In recent years, advances in understanding of this association have occurred in six major areas: animal models, biologic mechanism of lung injury, dose-response relationship, isolation from diseased patients, detection methods, and intervention. The association demonstrates strength, consistency, coherence, and specificity.

Recently, there have been reports of severe illness as a result of indoormold exposure, particularly due to Stachybotryschartarum. Here, we review the evidence regarding indoormold exposure and mycotoxicosis, with an emphasis on S. chartarum. We also examine possible end-organ effects, including pulmonary, immunologic, neurologic, and oncologic disorders. We discuss the Cleveland infant idiopathic pulmonary hemorrhage reports in detail, since they provided important impetus for concerns about Stachybotrys.

The toxicodynamic properties of trichothecenes include inhibition of protein synthesis and immunomodulatory effects. Very little information is available relating to their toxicokinetics and toxicodynamics in humans. While there is general agreement that the diet represents an important source of human exposure to trichothecenes, risk assessment from non-dietary routes of exposure is complicated by the limited epidemiological data that are currently available.

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Black mold and human illness. Texas medicine. 2002;98:53–56.

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Page E. H., Trout D. B.. The role of Stachybotrys mycotoxins in building-related illness. AIHAJ : a journal for the science of occupational and environmental health and safety. 2001;62:644–648. PMID: 11669391

A literature review indicates that currently there is inadequate evidence supporting a causal relationship between symptoms or illness among building occupants and exposure to mycotoxins. Research involving the identification and isolation of specific fungal toxins in the environment and in humans is needed before a more definitive link between health outcomes and mycotoxins can be made.

The presence of Stachybotrys in a building does not necessarily imply a cause-and-effect relationship with illness, but should alert physicians and healthcare professionals to do more vigorous environmental testing. Guidelines are presented herein for intervention measures in the maintenance of heating, ventilation, and air-conditioning systems.

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Sudakin D. L.. Stachybotrys chartarum: current knowledge of its role in disease. MedGenMed : Medscape general medicine. 2000;2. PMID: 11104457

Although the hazards associated with exposure to some mycotoxins have been well studied, the health risks from environmental exposure to Stachybotrys remain poorly defined.

A variety of respiratory, dermatological, eye and constitutional symptoms have been associated with heavy and prolonged exposure to S chartarum. S chartarum has also been potentially implicated as a rare cause of idiopathic pulmonary hemorrhage in infants. Buildings found to be heavily contaminated with molds, particularly S chartarum, should undergo thorough cleaning and repair to remove the offending agent(s), and prevent further water damage and mold overgrowth.

A critical review of papers, reports, and studies on Stachybotrys mycotoxins revealed only descriptive reports of suspected animal and human poisoning secondary to consumption of mold-contaminated food products. No studies of good toxicologic and epidemiologic designs answer whether airborne mycotoxins produced by Stachybotrys could produce specific human toxicity.

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